IOP Changes Research Articles

Augmented MP-TSCPC for the management of elevated IOP in glaucomatous eyes

Purpose: To compare the effectiveness and safety of augmented vs. traditional Micropulse transscleral cyclophotocoagulation (MP-TSCPC) settings in the treatment of glaucoma. Methods: Retrospective case-control study. The main outcome measures were the Kaplan-Meier analyses comparing the cumulative probabilities of survival between the augmented and traditional MP-TSCPC groups in terms of IOP and glaucoma medication reduction. Augmented MP-TSCPC consisted of treatment with a higher mean power, longer duration, and use of both sweeping and stopand-continue techniques. Additional outcome measures included changes in average IOP, number of glaucoma medications, visual acuity, and the prevalence of complication rates. Measurements were obtained at 1 day, 1 week, 6 weeks, 3 months, 6 months, and 1 year postoperatively. Results: 45 eyes of 45 patients were included in the augmented MP-TSCPC group, and 45 eyes of 45 patients were included in the traditional MP-TSCPC group. The mean IOP reductions at 1 year were 7.93 ± 10.05 mm Hg and 7.55 mm Hg (p=0.9) in the augmented and traditional MP-TSCPC groups, respectively. There were no significant differences in the prevalence of complications reported at any postoperative visits. There was a significant difference between the survival curves of the augmented and traditional MP-TSCPC in terms of both IOP reduction (p=0.041), and glaucoma medication reduction (p=0.037). Conclusions: Augmented MP-TSCPC appears to provide for greater long-term IOP control than traditional MP-TSCPC without compromising safety.

The Effect of Dietary Vitamin K1 Supplementation on Trabecular Meshwork and Retina in a Chronic Ocular Hypertensive Rat Model.

PurposeThe pathophysiologic relationship between vitamin K and glaucoma remains largely unknown. The aim of the study was to explore the effect of dietary vitamin K supplementation in a rat glaucoma model.MethodsRats were randomly divided into two groups: standard diet and high vitamin K1 (VitK1) diet (300 mg VitK1/kg diet). Induction of chronic ocular hypertension by episcleral vein cauterization was performed on the right eye. The left eye with sham operation served as controls. Rats received standard or high VitK1 diets for 5 weeks after surgery until the end of experiment. Immunohistochemistry analyses of the retina and trabecular meshwork were performed. The change in coagulation function and IOP were evaluated.ResultsWe observed a significant declined IOP at 2 weeks after surgery in the high VitK1 group compared with the control group. High VitK1 showed no significant effect on the body weight, rat phenotypes, or coagulation function. High VitK1 significantly inhibited the loss of retinal ganglion cells in the retina and increased the expression of matrix gla protein. High VitK1 also ameliorated the collapsed trabecular meshwork structure and increased collagen staining in the trabecular meshwork.ConclusionsHigh VitK1 intake inhibited the loss of retinal ganglion cells during glaucomatous injury, probably by increasing the expression of matrix gla protein. A transient decrease in the IOP was observed in the high VitK1 group, implying a potential effect of VitK1 on aqueous outflow. Retinal ganglion cells protection by high VitK1 supplementation may be due to the IOP-lowering effects as well as neuroprotective effect. Further research is required to delineate these processes.

Systemic β-Blockers Do Not Affect Glaucoma Eye Drop Effectiveness

In this secondary analysis of clinical trial data evaluating IOP elevation following pre-randomization washout of glaucoma eye drops, use of systemic beta-blockers was not associated with a statistically or clinically significant difference in IOP change.

Intraocular pressure-lowering effects of ripasudil in uveitic glaucoma, exfoliation glaucoma, and steroid-induced glaucoma patients: ROCK-S, a multicentre historical cohort study

To evaluate the efficacy and safety of ripasudil for treatment of secondary glaucoma, a historical cohort study was conducted at 18 centres in Japan. Adults (age ≥20 years) who needed additional IOP reduction and received topical 0.4% ripasudil between 2014 and 2018 due to three secondary glaucoma subtypes, including uveitic glaucoma (UG), exfoliation glaucoma (EG) or steroid-induced glaucoma (SG) were assessed for mean IOP change from baseline prior to additional treatment with ripasudil. We further evaluated the IOP change in each glaucoma subtype, baseline characteristics of each cohort, course of uveitis-induced inflammation in UG eyes, and proportion of patients in each cohort with adverse events. In 332 eyes from 332 patients eligible for this study, the mean overall IOP reductions from baseline at 1, 3, and 6 months were −5.86 ± 9.04 mmHg (−19.4 ± 25.1%), −6.18 ± 9.03 mmHg (−20.0 ± 27.1%), and −7.00 ± 8.60 mmHg (−23.4 ± 25.6%), respectively. These changes were all statistically significant. Of 332 eyes, 109 eyes had UG, 181 had EG, and 42 eyes had SG. The IOP-lowering effects of ripasudil in UG and SG were significantly greater than those of EG at every time point. This finding could have been related to higher baseline IOP levels in UG and SG. UG patients exhibited significant decreases in mean cell score of the anterior segment after ripasudil treatment. No severe adverse events were reported. These findings suggest that treatment with ripasudil is a safe and effective therapeutic modality for IOP reduction in secondary glaucoma.

Scleral concave pool trabeculectomy combined phacoemulsification in primary open-angle glaucoma with cataract

BackgroundTo investigate the safety and efficacy of scleral concave pool trabeculectomy (SCPT) combined phacoemulsification for eyes with coexisting cataract and primary open-angle glaucoma (POAG).MethodsThis was a retrospective, controlled, interventional pilot case series. Thirty patients (30 eyes) were diagnosed with coexisting cataract and POAG between May 2015 and April 2018. Fourteen eyes underwent SCPT combined phacoemulsification were set as the study group, and 16 eyes received conventional phacotrabeculectomy were set as the control group. All patients were followed up for at least 6 months. The preoperative to postoperative changes in IOP, glaucoma medication requirements, BCVA, blebs functions, and adverse events were recorded.ResultsThe groups were matched for baseline age, BCVA, IOP and types of IOP-lowering medications (all P > 0.05). At 6-month visit, there were no significant difference between control and study group in the improvement of BCVA (0.22 ± 0.24 versus 0.18 ± 0.26, P = 0.718), reduction of IOP (− 11.21 ± 8.61 mmHg versus − 9.19 ± 9.18 mmHg, P = 0.540) and the number of eyes that needed IOP-lowering medications (2 versus 3, P = 0.743). At the last visit, the rate of forming functioning blebs was significantly different between the study and control groups, (92.9% versus 68.7% respectively, P = 0.007). In the study group, 5 eyes developed hypotony, and 1 eye showed limited choroidal detachment, whereas in the control group 1 eye developed malignant glaucoma. All adverse events were successfully managed.ConclusionThe SCPT combined phacoemulsification seems to be a safe and effective alternative to conventional phacotrabeculectomy for patients with POAG and visually significant cataract in the short-term.

Improving Positive Life Event Predictions through Cognitive Behavioral Therapy

Depression is characterized by a tendency to overestimate the probability of negative life events and underestimate the probability of positive events. Although cognitive behavioral therapy (CBT) targets overly negative future expectations, research has yet to examine how such expectations change relative to one’s experiences. We examined the relation between predictions and event occurrence for positive and negative life events (i.e., informativeness of predictions [IoP]) among patients in CBT for depression. We examined how IoP changed over the course of CBT and whether these changes were related to CBT skill acquisition or symptom reduction. At intake and posttreatment, 67 patients were asked to estimate the probability of 40 events in the following week; patients later reported whether the events occurred. IoP improved for positive but not negative events across treatment. IoP for positive (but not negative) events were also associated with symptoms at intake and therapist-rated CBT skills at posttreatment. However, neither positive nor negative event IoP changes were associated with symptom improvement over the course of CBT. These findings suggest changes in the informativeness of predictions of positive life events may uniquely change and be important to the development of skills in CBT for depression.

Dose-dependent effects of netarsudil, a Rho-kinase inhibitor, on the distal outflow tract

PurposeTo characterize the effects of netarsudil on the aqueous humor outflow tract distal to the trabecular meshwork (TM). We hypothesized that netarsudil increases outflow facility in eyes with and without circumferential ab interno trabeculectomy (AIT) that removes the TM.MethodsSixty-four porcine anterior segment cultures were randomly assigned to groups with (n = 32) and without circumferential AIT (n = 32). Cultures were exposed to 0.1, 1, and 10 μM netarsudil (N = 8 eyes per concentration). For each concentration, IOP and vessel diameters were compared with their respective pretreatment baselines. Outflow tract vessel diameters were assessed by spectral-domain optical coherence tomography (SDOCT) and rendered in 4D (XYZ time series).ResultsNetarsudil at 1 μM reduced IOP both in eyes with TM (− 0.60 ± 0.24 mmHg, p = 0.01) and in eyes without TM (− 1.79 ± 0.42 mmHg, p < 0.01). At this concentration, vessels of the distal outflow tract dilated by 72%. However, at 0.1 μM netarsudil elevated IOP in eyes with TM (1.59 ± 0.36 mmHg, p < 0.001) as well as in eyes without TM (0.23 ± 0.32 mmHg, p < 0.001). Vessels of the distal outflow tract constricted by 31%. Similarly, netarsudil at a concentration of 10 μM elevated IOP both in eyes with TM (1.91 ± 0.193, p < 0.001) and in eyes without TM (3.65 ± 0.86 mmHg, p < 0.001). At this concentration, outflow tract vessels constricted by 27%.ConclusionIn the porcine anterior segment culture, the dose-dependent IOP changes caused by netarsudil matched the diameter changes of distal outflow tract vessels. Hyper- and hypotensive properties of netarsudil persisted after TM removal.

Effect of trabeculectomy and Ahmed glaucoma valve implantation surgery on corneal biomechanical changes.

To evaluate alterations in corneal biomechanical properties before and 6months after conventional trabeculectomy (TRAB) and Ahmed glaucoma valve (AGV) implantation. Thirty-nine eyes of 39 patients were evaluated retrospectively. Complete ophthalmological examinations including evaluation of corneal biomechanical properties using the Ocular Response Analyzer were performed before and after 6months postoperatively. A mean of four measurements for corneal hysteresis (CH), corneal resistance factor (CRF), Goldmann correlated intraocular pressure (IOPg), and corneal compensated intraocular pressure (IOPcc) was recorded. The participants had undergone trabeculectomy or shunt surgery as the first surgical procedure for glaucoma treatment of uncontrolled IOP with maximum antiglaucoma eyedrops. There were 20 eyes of 20 patients in trabeculectomy group and 19 eyes of 19 patients in AGV implantation group. There was no significant difference between two groups in terms of sex, age, eye laterality, lens status, antiglaucoma drug usage, preoperatively measured Mean Deviation of Humphrey Visual Field Analyzer, CH, CRF, IOPcc, and IOPg (p > 0.05). CH and CRF increased significantly after shunt surgery (p < 0.001). CH increased in trabeculectomy group postoperatively (p < 0.001); however, CRF showed a small amount of decrease, but this reduction was not statistically significant (p > 0.05). CH and CRF showed higher increase after AGV surgery than trabeculectomy surgery (p < 0.05). There was no significant correlation between IOP changes and CH-CRF changes in both TRAB and AGV groups (p > 0.05). According to our results, surgical technique differences may have an impact on postoperative corneal biomechanical outcomes. AGV surgery offers better corneal biomechanical results than standard trabeculectomy in 6-month follow-up.

Safety and efficacy outcomes of the Xen45 Gel Stent use for refractory glaucoma: a surgery series from surgeon trainees at a tertiary teaching hospital

BackgroundTo study the effect of an ab interno gelatin stent (XEN45 Gel Stent, Allergan Inc., Irvine, California, USA) on intraocular pressure (IOP) as placed by glaucoma fellowship trainees in eyes with refractory glaucoma.MethodsA prospective noncomparative study at a tertiary training center on 28 unique eyes undergoing ab interno gelatin stent implantation by glaucoma fellowship trainees. Data was collected at baseline and postoperatively at day 1, week 1, and months 1, 3, 5, and 12. Primary outcome was mean IOP change. Secondary outcomes included change in number of glaucoma medication classes and visual acuity. Safety outcomes included needling rates. Surgical success was defined by achieving ≥20% reduction in IOP with the same or fewer classes of antiglaucoma medications from baseline without the need for secondary surgical intervention and/or stent removal.ResultsAt baseline, 28.6% (8/28) of the subjects had prior failed incisional glaucoma surgery in a study population that was 54% African-American, with 78% with severe glaucoma (average mean deviation of − 14.58 dB). Thirteen subjects terminated their clinic visits before their 12-month postoperative visit, leaving 15 subjects for end point analysis. Average IOP went from 21.6 mmHg (range 12.0–31.0, SD 6.6) at baseline to 12.5 mmHg (range 7.0–19.0, SD 3.6), a 42.1% reduction (p < 0.007). All subjects decreased the number of medication classes they were taking with an average reduction of 3.8 (range 2–5, SD 0.9) to 1.3 (range 0–3, SD 1.0) classes, or a 65.8% decrease (p < 0.006). Crude surgical success was 80.0% for the 15 subjects that followed up at 12 months. The Kaplan-Meier cumulative probability of success for all 28 subjects at 12 months was 70.4% (95% CI: 44.7–85.8%). Regardless of the length of follow-up, 21.4% (6/28) met failure criteria: 3 subjects failed because they required secondary surgical intervention, and the other 3 did not have adequate IOP reduction. Initial bleb needling rate was 28.6% (8/28) and repeat was 17.9% (5/28).ConclusionsCompared to the reported literature with experienced ocular surgeons, ab interno gel stent placements by glaucoma fellowship trainees have similar mean IOP, topical medication reduction, surgical success, and needling rates at 12-month follow-up.

The effects of negative periocular pressure on intraocular pressure

Glaucoma is a major cause of blindness, and IOP reduction remains the only clinically-validated therapy. In this study, we analyze a novel IOP-lowering strategy that uses a modest negative pressure (vacuum) applied locally to the periorbital region by a pair of goggles with each lens individually connected to a programmable pump. Motivated by clinical data showing an IOP reduction, we used an existing validated lumped-parameter model of the eye to understand the putative mechanism of this treatment. The model considers aqueous humor dynamics, episcleral venous pressure, and changes in ocular blood volume to describe how IOP changes with time in response to an external perturbation. We find that clinical data are qualitatively and quantitatively consistent with model predictions if we include two primary mechanisms in the model: first, negative pressure application causes a relatively rapid increase in globe volume accompanied by increased blood volume in the eye. Second, negative pressure application reduces episcleral venous pressure, causing a slower adjustment of IOP due to altered aqueous humor dynamics. These results provide testable hypotheses that hopefully will lead to a fuller experimentally-driven understanding of how negative periocular pressure influences IOP. Evaluating the long-term effects of such treatments on glaucoma patients requires further clinical study.

EDI-OCT choroidal thickness in Posner–Schlossman syndrome

To compare the choroidal thickness (CT) of the affected eyes with the contralateral eyes in the active period and in the remission period in Posner-Schlossman syndrome (PSS) using EDI-OCT. This prospective longitudinal study included 15 patients with PSS and 15 age- and sex-matched healthy subjects. All subjects underwent complete ophthalmologic examinations, and EDI-OCT was conducted to measure macular CT (mCT) at the subfoveal locations and at 0.5, 1.0 and 2.0mm superior, inferior, nasal and temporal to the fovea. The mean measurements at each location were used for analysis. Linear regression analysis was performed to analyse the correlation between the choroidal thickness and IOP, and the correlation between the choroidal thickness and episode time. The mean mCT was significantly thinner in affected eyes than in contralateral eyes in the acute phase (p = 0.010) but were not different in the remission phase (p = 0.404). The mean mCT was significantly increased in the remission phase compared to that in the acute phase in the affected eyes (p = 0.000). The mCT of healthy subjects was significantly thicker than in the affected eyes (p = 0.020) and similar to the fellow eyes of PSS patients (p = 0.357) in the acute phase. Linear regression analyses show negative correlations between the mCT changes and IOP changes in the affected eyes compared to those in the fellow eyes in the acute period (R2 = 0.396, p = 0.033) and between the mCT changes and IOP changes from the acute period to the remission period in the affected eyes (R2 = 0.372, p = 0.027). Linear regression analyses show positive correlations (age- and sex-matched) between the CT changes and episode time from the affected eyes to the fellow eyes in the acute period (R2 = 0.492, p = 0.012). The mCT values of the PSS-affected eyes were significantly thinner than those of the fellow eyes in the acute phase and in the remission phase, and this change was correlated with IOP reduction and episode time.

PATTERN OF IOP CHANGES FOLLOWING Nd-YAG LASER CAPSULOTOMY FOR PCO

PURPOSE: To study the pattern of IOP changes following Nd-YAG capsulotomy for PCO and to calculate the percentage of patients requiring antiglaucoma medication following YAG laser capsulotomy. Study Design: Prospective study Material and Methods: The study was conducted in the department of ophthalmology in GMC Jammu. Patients who complained of diminution of vision due to posterior capsule opacification were enrolled. 50 patients who underwent Nd-YAG laser posterior capsulotomy were taken. After Nd: YAG, IOP was recorded after 1hr, 4hrs, weekly till 1 month to look for any pressure spike. Cases were followed upto 3 months to look for cystoid macular oedema, IOP rise, persistent iritis, vitritis, pitting of IOL and retinal detachment. Result: It was observed that intraocular pressure starts rising immediately after Nd-YAG, reaching a peak at 3-4 hours. It remains elevated at 24 hrs and returns to baseline in 1-week duration in most cases. Immediate IOP rise occurred in 21(42%) cases. At the end of 1 week, 6(12%) patients still had raised IOP. At 2 weeks, 3 cases showed high IOP among whom 2 returned to prelaser values at 1 month. Only 1 case had high IOP after 1-month duration. Only 1(2%) patient developed IOP elevation of >5 mm hg from prelaser values which did not return to baseline even after 1 month of laser and hence required antiglaucoma medication. Hence, according to this study 2% of cases require antiglaucoma medication to counter IOP rise following Nd-YAG. CONCLUSION: - IOP elevation associated with Nd: YAG laser is often transient without long-term damage and is typically observed within 2 to 4 hours after treatment. However, sometimes, IOP may rise high, requiring additional intervention. Hence it is important to monitor IOP post-YAG-Laser and do appropriate intervention to prevent unwanted consequences from raised IOP.

Preservative-free fixed combination in the treatment of open-angle glaucoma and ocular hypertension: the VISIONARY Study (EUPAS22204)

To evaluate efficacy, tolerability, and safety of PF tafluprost/timolol FC in patients with primary open-angle glaucoma (POAG) and ocular hypertension (OH) who couldn't tolerate or gave insufficient response to topical beta-adrenoblockers or prostaglandin analogue monotherapy. The prospective multicenter European VISIONARY study (EUPAS22204) included 87 patients from 7 ophthalmological centers in Russia with mean age of 63.9±11.8. Primary endpoint was mean IOP change at month 6. The patients were monitored for changes in in the severity of ocular signs and symptoms. Statistically significant (p<0.0001) reduction of mean IOP from baseline was seen at all study visits: 7.3±5.17 mmHg at week 4, 7.4±5.40 mmHg at week 12, and 7.1±5.10 mmHg at month 6. By month 6, IOP has decreased by 20; 25; 30 and 35% from baseline in 77.0%, 58.9%, 43.7%, and 31.0% of study patients, respectively. Conjunctival hyperemia was significantly reduced at all study visits. Significant reductions in dry eye symptoms (p<0.0010), irritation (p=0.0204) and itching (p=0.0010) were also observed. After 6 months on PF tafluprost/timolol FC, 85.7% of patients described it as easy or very easy to tolerate. In clinical practice, PF tafluprost/timolol FC provided statistically significant IOP reductions in patients with POAG and OH insufficiently controlled by or intolerant to monotherapy with topical beta-adrenoblockers or a prostaglandin analogue. The highest IOP reduction was seen at week 4 and was maintained over the 6-month study period. There was also a decrease in the severity of symptoms of ocular surface condition.

The Outcomes of Switching from Short- to Long-Term Intravitreal Corticosteroid Implant Therapy in Patients with Diabetic Macular Edema

Background: First-line treatment for diabetic macular edema (DME) is usually with antivascular endothelial growth factor agents, followed by intravitreal corticosteroids as a second-line treatment option. Long-term corticosteroids may offer quality of life and effectiveness benefits over short-term implants. Objectives: To evaluate outcomes of patients with persistent or recurrent DME who switched from a short-term (dexamethasone) to a long-term (fluocinolone acetonide, FAc) corticosteroid intravitreal implant in a real-world setting. Methods: This is a retrospective study in 9 Portuguese centers. An FAc intravitreal implant was administered according to product labeling. Effectiveness outcomes were mean change in visual acuity (VA; ETDRS letters), central retinal thickness (CRT; µm), and macular volume (MV; mm³). The safety outcome was mean change in intraocular pressure (IOP; mm Hg). All were analyzed at months 1 and 3, and then quarterly until month 24 after implantation. Results: Forty-four eyes from 36 patients were analyzed. Mean duration of DME was 3.3 ± 1.9 years, and mean follow-up was 8 months. From baseline following FAc implantation, VA increased significantly at months 1 and 6 (mean +6.82 and +13.02 letters, respectively; p = 0.005), and last observation carried forward (LOCF; mean +8.3 letters; p = 0.002). CRT improved significantly at months 1 and 6 (mean –71.81 and –170.77 µm, respectively; p = 0.001), and LOCF (mean –121.46 µm; p = 0.001). MV was consistently, but not significantly, decreased from baseline to LOCF (mean –0.69 mm³; p = 0.062). The mean change in IOP was –0.25 and +0.88 mm Hg at months 1 and 6, respectively (p = 0.268), and +1.86 mm Hg at LOCF (p = 0.036). Increases were controlled with topical medication in most cases. Conclusions: The FAc intravitreal implant is effective in patients previously treated with short-term corticosteroid implants. Thus, after a suboptimal response to antiangiogenics or a short-term corticosteroid, a single FAc implant may be considered an effective and tolerable treatment that can improve long-term outcomes for patients with sight-threatening DME.

PMD56 NETWORK META-ANALYSIS OF THE USE OF ISTENT® INJECT MICROINVASIVE SURGERY IN COMBINATION WITH PHACOEMUSIFICATION FOR GLAUCOMA AND CATARACT PATIENTS

To perform a network meta-analysis (NMA) on the use of iStent® Inject microinvasive surgery in combination with phacoemulsification and the other surgeries currently used in combination with phacoemulsification. Through a systematic review of the literature, a total of 9 studies were selected for the conduct of the NMA. Specifically, we selected those studies that presented the results in terms of % of patients reaching an IOP <21mmHg and changes in real IOP terms between basal and final. In those cases where the standard deviations of the mean reduction were not reported, it was imputed through the correlation of the studies that did present these data. Some studies required imputation of basal and subsequent standard deviation. Different scenarios were evaluated using fixed-effects and random-effects models with meta-regressions where study outcomes were additionally modified as well as the inclusion or non-inclusion of covariates: sex, age, basal IOP and months. The quality of the included studies was assessed and then used to weigh the effects of each of the studies. The fixed effect models for % patients with IOP<21mmHg and for change in IOP show that different surgeries complementary to phacoemulsification would not have a statistically superior effect. However, iStent® inject would have a favourable trend compared to phacoemulsification. This trend is maintained in random-effects models, however, and due to poor evidence and quality of evidence, confidence intervals are increased reducing the effect of treatments. iStent® inject technology in combination with phacoemulsification should be considered an effective and valid option in comparison to phacoemulsification. The other surgeries would not have a statistically significant effect. More face-to-face studies are required to have better evidence.

A multimodal ophthalmic analysis in patients with systemic sclerosis using ocular response analyzer, corneal topography and specular microscopy

To conduct a multimodal ophthalmic evaluation of systemic sclerosis (SSc) in patients using ocular response analyzer (ORA), Pentacam, and specular microscopy (SM). Thirty-one SSc patients and a group of age- and sex-matched controls were enrolled in this cross-sectional study. Corneal hysteresis (CH), corneal resistance factor (CRF), corneal-compensated intraocular pressure (IOPcc), and Goldmann-correlated IOP (IOPg) were measured with ORA. Anterior chamber depth (ACD), central corneal thickness (CCT), and corneal volume (CV) measurements were obtained using Pentacam. Corneal endothelial cell density (ECD) and CCT were evaluated by SM. SSc patients had significantly lower CH, ACD, and ECD values compared to the control group (p = 0.018; < 0.001; < 0.001, respectively). There was no significant difference regarding CRF, IOP, CV, or CCT measurements acquired by Pentacam and SM. Regarding CCT, SM and Pentacam showed relatively better agreement in SSc patients. Multimodal imaging can provide more comprehensive and useful information regarding the ocular involvement of systemic diseases. The multimodal evaluation in our study demonstrated that the pathologic effects of SSc may manifest as reductions in ACD, corneal elasticity, and ECD before there are any detectable changes in corneal thickness or IOP.

Assessment of Ganglion Cell Complex and Peripapillary Retinal Nerve Fiber Layer Changes following Cataract Surgery in Patients with Pseudoexfoliation Glaucoma.

Purpose To assess eye pressure, ganglion cell complex, and retinal nerve fiber layer changes following cataract surgery in patients with pseudoexfoliation glaucoma. Methods Eighty-five patients with pseudoexfoliation glaucoma (PEXG) were included in the study. They were divided into two groups; the first group included patients with PEXG and cataract who underwent phacoemulsification (pseudophakic group; n = 40 eyes). The second group included patients with PEXG without cataract (control group; n = 45 eyes). Both groups were on antiglaucoma treatment. IOP changes after surgery and the ganglion cell complex (GCC) and peripapillary retinal nerve fiber layer (pRNFL) thicknesses were evaluated in patients underwent cataract extraction surgery compared to controls that did not have cataract, nor underwent surgery. Both groups were followed up postoperatively for 18 months. Results There was no difference in the mean age and glaucoma stage in both groups (P=0.242 and 0.70, respectively). In the pseudophakic group, the mean IOP significantly dropped from 20.43 ± 0.90 to 17.00 ± 2.75 mmHg at the end of the follow-up period (P ≤ 0.001). Slight decrease (≈3 μm) was recorded in the mean GCC thickness of the pseudophakic patients from the baseline at the end of the follow-up period. This decrease was lower than that of the controls (≈5 μm). No significant pRNFL changes were recorded all over the postoperative visits (88.78 ± 22.55 μm at 3 months, 88.67 ± 23.14 μm at 6 months, 87.62 ± 23.04 μm at 12 months, and 87.32 ± 22.61 μm at 18 months) as compared to preoperative value (90.28 ± 22.31 μm) with P=0.335, 0.387, 0.158, and 0.110, respectively, or controls (89.69 ± 21.76 μm, 88.73 ± 21.08 μm, 87.33 ± 20.67 μm, and 87.23 ± 20.54 μm with P=0.850, 0.990, 0.951, and 0.984). Conclusion Phacoemulsification and IOL implantation may aid in managing pseudoexfoliation glaucoma by lowering IOP and slowing the rate of GCC and pRNFL losses over a short-term period.

Twelve-month outcomes of excisional goniotomy using the Kahook Dual Blade® in eyes with angle-closure glaucoma.

PurposeTo characterize clinical outcomes following Kahook Dual Blade® (KDB)-assisted goniosynechialysis and excisional goniotomy combined with phacoemulsification in eyes with angle-closure glaucoma and cataract.SettingTwo clinical practices.MethodsIn this retrospective analysis of existing health records, data were collected from 42 eyes of 24 subjects from preoperative, operative, and postoperative encounters through 12 months of follow-up. Outcomes included changes in mean IOP, IOP-lowering medications, and logMAR best-corrected visual acuity (BCVA), as well as the proportions of patients achieving IOP reductions ≥20%, IOP ≤18 mmHg, and a reduction of ≥1 medication.ResultsPreoperative, mean (standard error) IOP was 25.5 (0.7) mmHg and at Month 12 was reduced by 12.3 (0.73) mmHg (−47.2%; p<0.0001). The mean number of IOP-lowering medications used was 2.3 (0.1) preoperatively and was reduced at Month 12 by 2.2 (0.12) (−91.7%; p<0.0001). At Month 12, 92.9% of eyes achieved IOP ≤18 mmHg, 100% achieved IOP reduction of ≥20%, 95.2% required ≥1 fewer medications for IOP control, and 85.7% (36/42) were medication-free. Mean LogMAR BCVA improved from 0.547 (0.06) at baseline to 0.159 (0.07) at Month 12.ConclusionKDB-assisted goniosynechialysis and excisional goniotomy at the time of phacoemulsification safely provide significant reductions in both IOP and IOP-lowering medication burden in eyes with angle-closure glaucoma, while simultaneously improving visual acuity.

Home Tonometry Assists Glaucoma Drainage Device Management in Childhood Glaucoma.

The postoperative management of the nonvalved Baerveldt GDD presents challenges in pediatric patients due to widely variable IOP often occurring perioperatively. We evaluated the use of home tonometry in the management of Baerveldt implants for refractory childhood glaucoma. As part of an ongoing prospective study involving home rebound tonometry, the families of patients receiving Baerveldt implants were trained to use the Icare TA01i rebound tonometer and asked to document IOP, relevant symptoms, and ocular medication changes outside of the clinic setting. Data were analyzed for time to tube-opening, multiple-day fluctuations, and various IOP trends. Clinician response to IOP fluctuations detected by home tonometry was also evaluated. Included were 19 patients (mean age: 16.1±9.6 y) having Baerveldt implantation from 2015 to 2018 by 1 attending physician. Home tonometry detected 92.3% (12/13) of spontaneous tube-openings, which occurred at a mean of 6.0±0.5 weeks. By home tonometry, mean IOP decreased 32.7% (24 vs. 15 mm Hg, P<0.01); 5-day IOP fluctuation decreased from 15 mm Hg preoperatively to 8 mm Hg after tube-opening (P<0.05). Preoperative, postimplantation, and post-tube-opening IOP ranged from 10 to 59, 3 to 61, and 1 to 51 mm Hg, respectively. Home tonometry prompted 94 documented medication changes and validated 1 surgical decision among 14 patients. Home rebound tonometry accurately detected tube-opening and alarming IOP fluctuations, allowing clinicians to promptly and appropriately respond to these events. Home tonometry-augmented GDD management in childhood glaucoma may improve the care of these challenging patients.

Incidence and outcomes of ocular hypertension from rhegmatogenous retinal detachment surgery in the acute postoperative setting.

PurposeTo determine the incidence of ocular hypertension following surgery for rhegmatogenous retinal detachment in the first 3 months postoperatively and to determine their outcomes in terms of visual acuity, control of IOP, and changes in cup:disc ratio.Patients and methodsA single center prospective cohort study was done involving patients who underwent retinal surgery for rhegmatogenous retinal detachment. The patients were followed up for 3 months postoperatively and were monitored for development of ocular hypertension. The primary outcome measures were changes in IOP, visual acuity, and cup:disc ratio.ResultsOf the 52 eyes enrolled in the study, 19 eyes developed ocular hypertension in the first 3 months postoperatively, giving an incidence rate of 36.5% (95% CI, 48.9–76.0%). Analysis of mean IOP trends shows that most cases of IOP elevations occur in the first day postoperatively with a sustained elevation up to the first month and then returning to normal levels by the 3rd month. There is a significant increase in mean cup:disc ratio among patients who developed ocular hypertension (p=0.047). Visual acuity trends show that mean visual acuity significantly improved from baseline among cases who maintained normal IOP (p=0.002) as compared to those who developed ocular hypertension (p=0.97), although the difference in final visual acuity at the end of 3 months between groups was not statistically significant (p=0.30).ConclusionOcular hypertension may complicate retinal reattachment surgery. Control of IOP in the acute setting is essential to prevent development of secondary glaucoma.